Relationship of blood lead levels to personal hygiene habits in lead battery workers: Taiwan, 1991-1997

Am J Ind Med. 1999 Jun;35(6):595-603. doi: 10.1002/(sici)1097-0274(199906)35:6<595::aid-ajim7>;2-5.


Background: The blood lead concentrations of workers in lead battery factories are more than 4 times higher than those of the general population in Taiwan. Therefore, efforts are needed to reduce lead exposure in this high-risk population. A health promotion program on personal habits that reduce lead exposure has been carried out in a lead battery factory since 1991. This study investigated the longitudinal relationship of workers' blood lead concentrations and personal hygiene habits from 1991 through 1997.

Methods: In each of the 7 years of the study, occupational physicians questioned workers regarding nine personal hygiene items, personal information, and medical history before their annual health examination. The relationship between blood lead concentrations and personal hygiene habits was analyzed by longitudinal multiple regression in a mixed effect model with adjustment for potential confounders. In addition, the risk ratio of a blood lead concentration exceeding 40 micrograms/dL in men and 30 micrograms/dL in women (the action levels set by the Department of Health, Taiwan) was estimated by generalized estimating equations.

Results: Blood lead levels decreased significantly in the first 5 years of the study. The personal habits most closely related to blood lead concentrations were smoking at work sites (estimated coefficient = 3.13, P < 0.001), and eating at work sites (estimated coefficient = 1.38, P = 0.069). The risk ratio for workers with both these habits exceeding the action level of blood lead was 2.93 (95% CI 1.27-6.77). Difference in job titles, however, accounted for a major portion of the variance in blood lead. For example, working in "pasting" and "plate-cutting" was associated with blood lead elevations > 20 micrograms/dL in comparison to the "low- or no-exposure jobs."

Conclusions: Health promotion programs can decrease exposure of lead workers; reducing the practices of smoking and eating at work sites should be the core of such programs. However, a major reduction in lead exposure for some jobs (e.g., "pasting" and "plate cutting") in lead battery factories in Taiwan is unlikely to occur without major engineering changes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Feeding Behavior
  • Female
  • Hand Disinfection
  • Health Behavior*
  • Health Promotion / methods*
  • Humans
  • Hygiene*
  • Lead / blood*
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Multivariate Analysis
  • Occupational Exposure / prevention & control*
  • Odds Ratio
  • Taiwan


  • Lead